HomeMy WebLinkAbout03378 . t' •
F 4
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N° 3 3 7 8 r!
109 8th Street Suite 303 Assessor's Parcel No. ,
Glenwood Springs, Colorado 81801
Phone (303) 945-8212
; r
i - - This does not constitute i
V INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY 1 s
r` C -r :"
M 7 / n 3 - M�I Phone � J T I r
Owner's Name
'r ���� � V �" � C - Present Addra � °
System Location aZ 3ao 1 r'-I I. OP)
Legal Description of Assessor's Parcel No.
7 SYSTEM DESIGN b
■
—
O ?TL> Septic Tank Capacity (gallon) Other °
t f
/inch) Number of Bedrooms (or other) 3
30 Percolation Rate (minutes p
L 7' M-t U n_ t e I¢C H get e h�
` X035 S / //
Required Absorption Area- See Attached 4 ,'ZI of LEA - G(i(- C.(f gE25 / B t.D (3 et )) c c
r
Sig n't cH e 5 /A ?REAL S (ig'� i 4'
;R
Special Setback Requirements: _
h/
Date 7—/\-- on Inspector 111- Ol�'� i i
f i,
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) It f
' ' Call for Inspection (24 hours notice) Before Covering Installation
�, 8
System Installer �.�),�)ir k
ry
03
Septic Tank Capacity " 1
' Septic Tank Manufacturer or Trade Name
;, Septic Tank Access x within 8" of surface YL* / tLd� c /�2 •
Absorption Area , tea ( > L 4 rT / r Ifri I� &L$ �A lt I ` � L > `
y Absorption Area Type and /or Manufacturer or Trade Name r
' , Adequate compliance with County and State regulations/requirements y/S.j e
tF
/i
Other � / � , fi 4
,
Date a "zy �7a Ins 41"...... A t
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE i
k •CONDITIONS: le 1
i 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter Ep
25, Article 10 C.R.S. 1973, Revised 1984. '
2. This permit Is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- 'r
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a
f requirement of the permit and cause for both legal action and revocation of the permit. ' ?
• I° 1 3. Any person who constructs, alters, or installs an Individual sewage disposal system In a manner which involves a knowing and material
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 8 'i
months In Jail or both). 1
I i
s+ - - White- APPLICANT Yellow - . DEPARTMENT _ �__. �t 1+_.
Application
INDIVIDIJAI. SEWAGE. I)ISPOSAT. SYSTEM APPT.ICATION Approval By
County Official
OWNER /1 SA YAfie
ADDRESS rein CR eV, PHONElds•a6'7(
ONTRACTOR N/J
ADDRESS PHONE
ERMIT REQUEST FOR: 00 New Installation () Alteration () Repair
.Mach separate sheets or report showing entire area with respect to surrounding areas, topography of area,
abitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes
See page 4). �/ /
,OCATION OF PROPOSED FACTI.ITY : County afin /d
Tear what City or Town _ y.4 Lot Size 7. / A CRes
,egal Description 47 M- ./ /kph? -'£dt/i 14bik. Svr , 27,77S e 79 M', (7` PA !t .
WASTES TYPE : (k)' Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non - domestic Wastes
( ) Other - Describe
IUILDING OR SERVICE TYPE: /PM/ i✓t vrd
dumber of bedrooms_ 3 Number of persons -2
) Garbage grinder (kk Automatic Washer (Q Dishwasher
;OURCE AND TYPE OF WATER SI IPPLY: (X) well () spring () stream or creek
3ive depth of all wells within 180 feet of system:. /vow
f supplied by community water, give name of supplier:
;ROUND CONDITIONS:
)epth to bedrock: Qoo
)epth to first Ground Water Table: /i0'
'ercent ground slope: (%
)1STANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Vas an effort made to connect to community system? ND
'YPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(k) Septic Tank ( ) Aeration Plant ( ) Vault
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use
( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use
( ) Chemical Toilet ( ) Other - Describe:
?INAL DISPOSAL BY:
(),O Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? AD